Impacts of False Alarms in Critically Ill Patients with Heart and Lung Failure

描述（由申请人提供）：这个以患者为导向的指导研究职业发展奖的目的是为Christopher P. Bonafide，医学博士，MSCE，宾夕法尼亚大学和费城儿童医院儿科助理教授，他的长期目标是成为一名独立的临床研究科学家，专注于评估预防院内心脏骤停和其他不良事件的干预措施，并将有效的干预措施转化为临床实践。他的近期目标是获得必要的培训、指导和研究经验，以成功竞争R01资助，支持该领域的干预研究。为了实现这一目标，Bonafide博士和他的导师制定了一个全面的职业发展计划，包括四个组成部分，包括(a)临床信息学高级培训，事件分析时间和临床试验

DESCRIPTION (provided by applicant): The purpose of this Mentored Patient-Oriented Research Career Development Award is to prepare Christopher P. Bonafide, MD, MSCE, Assistant Professor of Pediatrics at the University of Pennsylvania and The Children's Hospital of Philadelphia for his long-term goal of becoming an independent clinical research scientist focused on evaluating interventions to prevent in-hospital cardiac arrest and other adverse events, and translating effective interventions into clinical practice. His immediate goal is to obtain the training, mentorship, and research experience necessary to successfully compete for R01 grants supporting intervention studies in this area. To meet this goal, Dr. Bonafide and his mentors have developed a comprehensive career development plan with four components, including (a) advanced training in clinical informatics, time-to-event analysis, and clinical trial design, (b) intensive mentorship from a team with whom Dr. Bonafide has a track record of collaboration and scholarship including Ron Keren, MD, MPH (primary mentor), Vinay Nadkarni, MD, MS (co-mentor), John Holmes, PhD (co-mentor), and Russell Localio, PhD (senior biostatistics advisor), (c) participation in collaborative research seminars with experts in clinicl effectiveness research, informatics, and medical device engineering, and (d) an innovative research plan to investigate the potential harms associated with physiologic monitoring technology, a critical tool in recognizing early signs of deterioration and preventing cardiac arrest. Despite their great potential, physiologic monitors can generate hundreds of alarms per patient each day, up to 86% of which are false. The candidate hypothesizes that false alarms lead to alarm fatigue, delaying responses to alarms that may represent true signs of impending cardiac or respiratory arrest, and unnecessarily interrupt high-risk tasks leading to errors and patient harm. Dr. Bonafide aims to rigorously evaluate these potential impacts of false alarms in a population of patients at high risk of cardiac arrest and other adverse events: critically ill children with existing or projected heart and/or lung failure. He will use video and direct observational methods to (1) evaluate the patient-oriented impact of alarm fatigue by measuring the association between the rate of false alarms and nurse response time to critical alarms, and (2) determine the association between interruptions due to physiologic monitor alarms and medication administration errors in this high-risk patient population. The findings will provide evidence to support and inform future R01 proposals focused on evaluating strategies to improve the signal-to-noise ratio of physiologic monitors and translating these strategies into clinical practice to prevent in-hospital cardiac arrest and other adverse events. The research and career development activities outlined above will take place in the collaborative academic environment of the University of Pennsylvania and The Children's Hospital of Philadelphia with the support of an internationally-recognized team of mentors and advisors, assuring Dr. Bonafide's success.